Orthostatic Hypertension
Orthostatic Hypertension is known as postural hypertension or head rush or dizzy spell.
Orthostatic hypertension is form of low blood pressure in which a person's low blood pressure falls when suddenly standing up or stretching.
Person's blood pressure decline >20mmHg 8n systolic blood pressure (SBP) or decline >10 mmHg in diastolic blood pressure when moves from supine to sitting or standing position.
Systolic blood pressure
Pressure exerted when blood is ejected into arteries.
Normal systolic blood pressure is 120mmHg.
Diastolic blood pressure
Pressure blood exerts within arteries between heartbeats.
Normal diastolic blood pressure is 80mmHg.
Clinical manifestations
Following symptoms can occur after sudden standing or stretching /after sitting.
1. Dizziness; feeling faint and unsteady
2. Bodily dissociation
3. Distortion in hearing
4. Light headness
5. Nausea
6. Headache
7. Seizures
8. Temporary decrease in hearing
9. Tinnitus (perception of noise)
10. Blurred or dimmed vision
11. Generalized numbness (tingling and fainting)
12. Coat hunger pain (pain centered in the neck and shoulders)
13. Vasovagal syncope
Etiology
Postural hypertension primary caused by gravity-induced blood pooling in lower extremities, result venous return, resulting decreased cardiac output and lowering arterial pressure.
Factors
1. Hypovolemia
2. Diseases
3. Medication
4. B12 deficiency
Diagnosis
Orthostatic Hypertension can be measuring a person's blood pressure.
1. After lying flat for 5 minutes
2. Then 1 minute after sitting
3. Then 3 minutes after standing
Blood pressure monitoring
Articles required;
1. Sphygmomanometer
2. Stethoscope
3. Kindney tray
4. Cotton swabs
5. Paper and pen
Procedure
1. Wash hands
2. Explain procedure to patient
3. Tie blood pressure cuff to patients aim at chest level
4. Clean the ear piece
5. Feel brachial pulse and place stethoscope there
6. Close the valve and inflate air in cuff until mercury reaches a point where pulse can't be heard.
7. Open valve slowly and permit air to escape. Note mercury where sound stops.
8. Allow air to escape and leave at zero.
9. Repeat same during sitting and standing
10. Recording and reporting
Management of Orthostatic Hypertension
1. Positioning
2. Intravenous fluids
3. Intravenous medication
Non- Pharmacologic Treatments
1. Adequate fluid intake, limit or avoid alcohol and exercise regularly in horizontal position.
2. Change posture slowly and avoid standing.
3. Spend sitting up each day in prolonged bed rest patients
4. Wear compression stocking
5. Avoid standing up suddenly
6. Avoid hot showers or excessive heat
7. Increase salt intake
Pharmacologic Treatments
A Vasoconstrictor Agent
1. Midodrine
2. Octreotide
3. DHE (Dihydroergotamine)
B. Fludrocortisone
Help control amount of sodium and fluids in body.
Reduce salt loss and expands plasma volume.
1. Corticosteroid
2. Mineralocorticoids
Dietary management at home
1. Holy basil (tulsi)
2. Milk and almonds
3. Carrot
4. Raisins (kishmish)
5. Lemon and salt
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